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Nurses' Lived Experiences of Faith-Based Short-Term Medical Mission Trips

Harner, Faith; Mann, Jeremy; Whitten, Carrissa; Abraham, Samuel P.; Gillum, Deborah R.

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doi: 10.1097/CNJ.0000000000000661
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Abstract

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It is estimated that upward of two million persons from the United States participate in short-term medical mission trips (STMMTs) every year in over 1,000 mission trips (ShortTermMissions.com, 2019). Yet, little is known about the impact of STMMTs on participants. What challenges do participants face during and after the trip? Are their lives changed? Is their healthcare practice altered? What support is needed before and after an STMMT?

Through STMMTs healthcare professionals are enabled to serve in unfamiliar environments to provide services to diverse populations. Sykes (2014) explained that volunteers are significantly influenced during medical mission trips. Participation in these experiences can result in spiritual impact or changes that may lead to enhanced personal and professional insight (Chuang et al., 2015; Prater et al., 2016). Thus, STMMTs provide opportunity for healthcare professionals to grow as individuals and enable them to meet needs of underserved people. The purpose of this study was to identify and explore the lived experiences of nurses who participated in faith-based STMMTs.

Of 67 studies published on medical mission trips since 1993, only 6% addressed short-term medical service trips, whereas 80% reported on surgical trips (Sykes, 2014). However, research was limited regarding the impact of international experiences (Vu et al., 2014). Thus, a substantial need exists for additional research on how STMMTs affect individuals who participate and whether learning occurs. The central research question of this study asked: What are the lived experiences of American-trained nurses who have participated in short-term, faith-based medical mission trips?

REVIEW OF LITERATURE

Subjective and objective experiences emerged through the literature review. Objective themes included preparation for trips and sustainable research. Subjective experiences included teamwork and communication, cultural competency, worldview, and healthcare practice. These subtopics were identified as recurring themes throughout published research studies.

Objective components of an STMMT found in the literature review include the imperative of pretrip assessments of self, needs, and assets of the host country to provide an enriched mission experience (Compton et al., 2014). Chuang et al. (2015) recognized how identifying pretrip concerns could help prepare individuals for a cross-cultural mission experience. These preparations also emphasized that teaching participants about the prevalence of disease, epidemics, cultural and religious barriers, and issues related to food, travel, money, and education enhance the learning opportunities.

One mixed-method study demonstrated that an STMMT team could conduct small-scale, on-site research and impact the development of health-promoting programs in a host country (Rovers et al., 2014). Compton et al. (2014) found that planning and preparation, as well as selecting qualified volunteers, were imperative. The idea of planning for best practice methods for an STMMT aligns with the suggestion that STMMT teams can provide a more sustainable impact through engaging qualified volunteers in on-site research (Rovers et al. 2014).

A subjective medical mission experience is composed of idiosyncratic learning processes. These facets of growth have the potential to change a person holistically. As previously noted, subjective STMMT components found in the literature included teamwork and communication, cultural competency, worldview, and healthcare practice. Numerous researchers (Brown et al., 2012; Gonzalez, 2013; Vu et al., 2014) addressed how individuals from the United States who participated in faith-based STMMTs experienced an increased sense of teamwork with other healthcare professionals, including improved interpersonal and communication skills.

Of note is how participating in medical mission trips provides valuable experiences in clinical medicine, patient and provider interaction, and physical assessment/diagnostic skills (Chuang et al., 2015). Increased cultural competency and communication skills are additional positive results (Vu et al., 2014). After returning from an STMMT, many participants better understood team dynamics and their roles on the healthcare team (Brown et al., 2012). The idea of interdisciplinary teamwork applies to the local community as well. Rovers et al. (2014) explored how American medical personnel established trust with key contacts such as Mali physicians, interpreters, guides, and village elders from the host country, which allowed for more active participation of the local people in the STMMT sustainable research study. Teamwork was enhanced when volunteers worked in an unfamiliar and uncomfortable environment (Gonzalez, 2013). A team in this setting learns to rely on the knowledge each participant offers.

Cultural awareness education programs before departure are known to potentially increase understanding in engaging with the local community in a culturally sensitive manner (Steinke et al., 2015). Also, participants have expressed increased awareness of global issues when given the opportunity to serve individuals with fewer resources (Chuang et al., 2015). In another study, STMMT participants could quickly adapt to new healthcare settings and better communicate with patients and other healthcare personnel, demonstrating stronger cultural competency (Vu et al., 2014).

Worldviews are proven to be positively affected by an STMMT. Individuals who participated in an STMMT experienced a change in perspective regarding the influence of one's culture on his or her health and a greater sense of personal and social responsibility (Prater et al., 2016; Vu et al., 2014). Reflecting on one's worldview is necessary to identify commonalities and differences between cultures. Through cultural engagement, underlying assumptions and ethnocentrism may be revealed. Thus, taking a posture of cultural humility is critical in understanding cultural differences. In this learning process, healthcare professionals may experience a spiritual transformation, seeking to appreciate others, which may ultimately reshape their worldviews.

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The skills of health personnel are broadened through service-learning, including improved diagnosis and treatment of patients (Chuang et al., 2015; Vu et al., 2014). Participants in international service-learning experiences also show more sensitivity and ability to address the needs of individuals in healthcare settings within the United States (Brown et al., 2012), whereas their knowledge of global diseases expands and adds awareness of issues in resource-poor settings (Chuang et al., 2015).

THEORETICAL FRAMEWORK

Leininger's transcultural nursing theory (Leininger & McFarland, 2002) guided this study. This theory provides a cultural framework for healthcare personnel, identifying the needs of individuals and communities from different cultures and how to provide culturally congruent care. The culture care diversity and universality theory can be applied to American-trained nurses who have engaged in STMMTs. Through this theoretical lens, nurses can evaluate their worldviews and cultural dimensions of different cultures encountered on STMMTs.

Leininger's Sunrise Model encompasses the major themes and ideas outlined in the culture care diversity and universality theory. The model addressed the problem statement by identifying potential influencing elements in the lives of American-trained nurses that impacted the care these nurses provided. The phrase “let the sun rise and shine” (Leininger & McFarland, 2002, p. 81) illuminates the idea for STMMT participants to expand their thinking and learn from others in different cultures. The application of the model provided a holistic understanding of how to approach culturally congruent care.

METHODS AND SAMPLE

Within this study, an STMMT was defined as a team of healthcare professionals who provide physical, mental, and spiritual care in a country outside of the United States. These trips lasted from 1 week to 6 months. For this study, it was assumed these trips were faith-based, with a Christian perspective.

Using a qualitative, phenomenological design, researchers collected data about the lived experiences of American-trained nurses. Lincoln and Guba's (1985) evaluation criteria for qualitative research were used to evaluate the study's trustworthiness. This involved assuring credibility in the findings by prolonged engagement with the participants and the environment and persistent observation, ensuring that information obtained was rich, robust, comprehensive, and well-developed. A peer debriefing technique gathered information from disinterested members. Prompts helped to keep focus on the topic and prevent deviations from the research. The researchers attempted to describe the phenomenon in detail to draw conclusions to match other times, settings, situations, and people. Two nursing professors, not involved in the research process, examined both the process and product of the research study to foster validity.

The college Institutional Review Board approved the study before interviews began. Participants signed informed consents before the interviews and could withdraw from the study at any time. All collected data were submitted to the School of Nursing, where staff scanned the data for storage on discs in a locked storage room. The data will be destroyed after 3 years. Colaizzi's approach was used to analyze the qualitative data (Wojnar & Swanson, 2007).

The interviewed population was a purposive and snowball sampling of male and female American-trained nurses who had participated in STMMTs and were age 18 years or older. Participants were personally known to the researchers or the faculty at the School of Nursing and included individuals who were currently registered nurses and had participated in an STMMT. Nurses who engaged in an STMMT while in nursing school were included in the study. The sample size was 15; participants were informed of the potential risks of the study and assured confidentiality.

Researchers used email to contact the nurses for an interview time and location. Participants completed demographic details before the interview. Locations of the interviews included the college campus or a mutually agreed location where the researchers and participants could meet privately in a distraction-free environment. Some interviews were conducted via live video, which included Facebook Live and Facetime. Informed consent was obtained via email; participants provided electronic signatures for the live video interviews.

The researchers began by asking the central research question. Prompts were given only when further guidance was needed. To promote open communication, researchers recorded each interview for verbatim transcription later.

DATA ANALYSIS

Researchers arranged emergent themes from qualitative data into categories. Frequency by individual word or phrase was calculated and frequency by clustered category was determined. The highest clustered category was ranked #1 and the lowest #7. Researchers analyzed the data using the steps of Colaizzi's method (Wojnar & Swanson, 2007), thoroughly examining and reexamining each interview. Key statements from the descriptions were highlighted. Creating worth from the participant statements guided the researchers in discovering subtle meanings from the phenomenon; they then organized these meanings into common themes. To ensure consistency, these formulated themes were evaluated in comparison with the original participant reflections. The researchers incorporated the results into an exhaustive description of the experience. Follow-up discussion with the participants, in the form of member checks, validated the research findings and ensured that the results reflected their experiences. Any changes in the phenomenon at the participant's request were integrated into the research.

The study sample included 2 males (13.3%) and 13 females (86.7%). All 15 participants stated that they had participated in a faith-based medical mission trip. When asked if they would go on a mission trip again, 14 (93.3%) stated yes. Table 1 provides the demographic data.

Table 1. - Participant Demographic Information (N = 15)
Question n %
Gender
   Male 2 13.3
   Female 13 86.7
Age range
   18-24 1 6.7
   25-34 3 20.0
   34-44 2 13.3
   45-54 5 33.3
   55-64 3 20.0
   65+ 1 6.7
How many times have you been on a mission trip?
   1-2 7 46.7
   3-4 2 13.3
   5-6 5 33.3
   7+ 1 6.7
Was the mission trip faith-based?
   Yes 15 100
What was your longest trip?
   7 days or less 3 20.0
   8 to 14 days 9 60.0
   15 days to 1 month 1 6.7
   Greater than 1 month 2 13.3
What was your shortest trip?
   7 days or less 10 66.7
   8 to 14 days 5 33.3
Would you go on a mission trip again?
   Yes 14 93.3
   Unsure 1 6.7
Visited Countries: Chad, Costa Rica, Dominican Republic, Ecuador, Gabon, Guatemala, Haiti, Hogan Indian Reservation (in the United States), Honduras, Jamaica, Kenya, Liberia, Mali, Nicaragua, Sierra Leon, Tanzania, Zimbabwe

RESULTS

Seven primary themes emerged from the study: 1) enhanced adaptability; 2) change in worldview; 3) greater sense of team dynamics; 4) change in nursing practice; 5) increased sense of purpose; 6) preparation and follow-up; and 7) sustainability.

Theme 1. Enhanced Adaptability. The first theme of enhanced adaptability accounted for 24.3% of the seven primary themes. The subthemes for enhanced adaptability included lack of resources in the host country (n = 12), challenging experiences (n = 14), flexibility (n = 13), and encountered cultural barriers (n = 14). The frequency by phrase for this overall theme was 53 out of 218 clustered categories. The theme of enhanced adaptability on an STMMT is concrete as supported by the data analysis, literature review, and participant experiences, as indicated by these comments:

I can't use all those resources that I'm used to using. So we really just had to utilize what we had: antibiotics, drinking water, and do that on a regular basis.

A lot of people look dry or they needed fluids, but you don't really have fluids to give them, which is pretty sad and depressing and you know where your meal is coming from, but they don't know where their meal is coming from.

Theme 2. Development of Worldview. For the theme of development of a worldview, subthemes included greater spiritual awareness (n = 13), increase in open-mindedness (n = 12), a greater appreciation for life in the United States (n = 9), and identification of materialism/poverty (n = 15). This theme accounted for 49 out of the 218 clustered categories and 22.4% of the seven primary themes. Participants shared:

I was trying to wrap my head around it...biblically and morally and... then you throw in that cultural dimension, and you realize, wow, things aren't always from the same lens that we look at them as.

Also thinking about the impact that the international trips have on our students and our faculty because it opens up your eyes to see what Third World medicine is like... you think about the homeless people in the United States, and you compare it to some of the people that we would see out in these Third World countries and our homeless people have more than what these people have.

Theme 3. Greater Sense of Team Dynamics. A greater sense of team dynamics included the subthemes of experienced communication and collaboration with the STMMT team and intercultural staff (n = 13), increased understanding of role on STMMT (n = 7), and integration with host culture (n = 9). This theme accounted for 29 out of the 218 clustered categories and 13.3% of the seven primary themes. One participant said,

Working in the hospital or clinic or whatever and depending on who you worked with, we all worked in one accord, we all had the same aspiration. There [were] no egos involved, we all remained humble; we all had a servant's heart towards what we were doing... When we all act like that, it's a beautiful thing.

Theme 4. Change in Nursing Practice. The fourth theme was a change in nursing practice with subthemes of individualized nursing care (n = 9), encountering new diseases and conditions (n = 6), and impact on current U.S. practice (n = 10). This theme contributed 25 out of the 218 clustered categories and 11.5% of the seven primary themes. Participants said,

Well you know, around here we're not going to see or treat typhoid, yellow fever, [or] malaria so I got to learn more about those things in certain countries.

How can I... take this energy that I'm focusing on being aggravated with everybody, make it into something different... I got into another area in work, and I'm working with perinatal death.

Theme 5. Increased Sense of Purpose. An increased sense of purpose also was observed. The subthemes included viewing a nursing career as a mission field (n = 10), reflection on life purpose (n = 8), and trial for long-term mission work (n = 5). This theme accounted for 23 out of the 218 clustered categories, and 10.6% of the seven primary themes. In their words, participants explained,

So that's why I say I'm in a mission field all of the time, no matter where I'm at or what I'm doing, and I even consider my students to be my mission field.

But I knew I also wanted to find out, could I do missions? Could I be a part of a missions thrust in my life? I mean, that was really big. That was before we got engaged. So, it was pivotal for me. If I couldn't handle this, then I didn't think we were going to end up being together.

Theme 6. Preparation and Follow-Up. The sixth theme was preparation and follow-up. The subthemes included adequate preparation (n = 9), inadequate preparation (n = 2), adequate follow-up (n = 3), and inadequate follow-up (n = 8). This theme accounted for 22 out of the 218 clustered categories, and 10.1% of the seven primary themes. Input related to this theme included,

We had a lot of prep through the college... they did a lot of prep with us, and the doctor did too... So we were prepared to go.

But the biggest thing I think we did to prepare was... read that book [Corbett & Fikkert, 2014]. And then I do remember that we... did something like cultural learning.

Although no research to date has described follow-up after a medical mission trip, the theme of lack of follow-up after an STMMT was prevalent in the data analysis. Many participants voiced how they concluded their STMMT without engaging in discussion or constructive reflection with their team afterward. Participants said,

I actually got depressed after coming home... You kind of go through a little bit of depression... One of the things is that I didn't get to share for quite a while....

I just sort of pushed it aside and said, Oh yeah, it happened, but it didn't really happen. It was just sort of a like a book; I read it once, and then I closed it.

Theme 7. Sustainability. The final theme was sustainability. The subthemes were empowering local people (n = 7) and lack of sustainability in the host country (n = 10). This theme accounted for 17 out of the 218 clustered categories and 7.8% of the seven primary themes.

However, in this study, the theme of sustainable research was not found to be true. Instead, the researchers' findings described a lack of sustainability. This was supported by participants who said, While you can't change their issues in one hospital stay, just like one week on a mission trip, you can't really change that. You can help them and teach them how to teach [others] things. Hopefully, they'll use that.

I struggled with international mission trips just a little bit because I'm all about making the long-term change and having the long-term impact and going in and doing. You know, seven days does not create long-term impact.

Another subtheme was empowering local people. Many participants articulated this through teaching local people proper health habits. One participant stated,

The Kenyan nurses got to see how we did it... They actually started their own clinics reaching out and meeting people and it was because we went in and modeled how to do it and how you don't have to just have people come to you. You go to them.

DISCUSSION

The participants' experiences were predominantly positive and memorable; however, participants also experienced various challenges not noted in the subthemes: culture shock, toilet facilities, cleanliness, language barriers, insect bites, weather conditions, food and waterborne illnesses. As challenges surfaced, the nurses said they learned to rely on God; some mentioned that their relationships with God strengthened.

Every day began and ended with devotions and prayer. Diligently seeking direction from God was the priority. Participants said they believed spiritual care in nursing is an important aspect of healthcare; all participants were comfortable providing spiritual care as needed.

Almost every participant said he or she would go on a mission trip again. Training prior to mission trips helped with essential tools to handle potential situations and reduce anxiety.

The findings supported Leininger's theory that has a unique emphasis on nursing as a means to know and help cultures. The Sunrise Model helped connect the concepts with actual clinical practices. In accordance with the theorist, participants in the STMMT needed to expand their worldview, adaptability, teamwork, nursing care, language use, and environment to understand cultural care phenomena. The STMMT experience is full of rich learning experiences. As educators at schools of nursing are challenged to inculcate cultural awareness into their programs, these mission trips are one way to bridge the gap.

Figure 1 illustrates the seven themes. The literature review supports the theme of adaptability. Vu et al. (2014) discovered that medical residents noted how participating in medical mission trips helped improve their ability to quickly adapt to a new healthcare setting and communicate with patients and other healthcare personnel. The literature also supported the theme of change in the worldview. The STMMT learning process offers healthcare professionals opportunity for spiritual transformation in seeking to appreciate others (Prater et al., 2016).

Figure 1.
Figure 1.:
Emergent Themes for Short-Term Medical Mission Trips

Team dynamics is another component of the international learning experience (Gonzalez, 2013). Working in an unfamiliar and uncomfortable environment with an ending goal does promote teamwork. A team in this setting learns to rely on the knowledge each participant offers. In the current study, the researchers expected to find enhanced communication between healthcare professionals, as suggested by the research (Brown et al., 2012; Chuang et al., 2015; Gonzalez, 2013). However, this study yielded results that were not consistent with prior literature in the areas of enhanced communication.

Regarding potential change in nursing practice, Brown et al. (2012) suggested that those who participated in STMMTs were more sensitive and able to address the needs of individuals in healthcare settings within the United States. Additionally, medical mission trips allow participants to increase their knowledge of diseases in the developing world and to become increasingly aware of issues in resource-poor settings (Chuang et al., 2015).

The theme of an increased sense of purpose was supported in the literature as participants experienced a greater sense of personal and social responsibility after participating in STMMTs (Vu et al., 2014). The theme of preparation and proper planning, including conducting a needs assessment as an ethical imperative, was noted (Compton et al., 2014). Chuang et al. (2015) recognized how identifying pretrip concerns could help prepare individuals for a cross-cultural mission experience. The concept of sustainability was observed (Rovers et al., 2014), in that STMMTs could be sustainable as their research demonstrated how a short-term volunteer group could conduct sustainable research and attain results. For example, this would impact the development of a local malaria prevention program for the host country.

Several limitations were clear. One was the lack of diversity among male to female RNs (ratio 2:13). On the technical side, at times words could not be heard on the recorder, thus causing difficulty in transcribing into verbatim text. Finally, several RNs participated in the same STMMT, which could potentially limit the diversity of the data.

IMPLICATIONS FOR NURSING PRACTICE

The study's findings highlight the adventure of participating in STMMTs, as well as identifying areas for improvement. Through participation, nurses can further refine their abilities to adapt to challenging or differing situations, develop their worldview, increase their sense of purpose, gain greater awareness of team dynamics, and experience development in their professional nursing practice. These opportunities offer individuals and organizations in the United States a chance to enhance their patient care skills, while impacting people in other countries. In Philippians 2:4 (ESV), we are cautioned to “look not only to your own interests, but also to the interests of others.” This became a reality to the participants.

RECOMMENDATIONS AND CONCLUSION

One recommendation is that nurses trained in the United States should participate in an STMMT because evidence suggests that an individual's cultural perspective can be impacted significantly. Secondly, STMMT leaders should strategically plan follow-up and debriefing after trips to facilitate adequate processing of the nurses' experiences. Through this learning opportunity, participants have an avenue for catharsis, if needed, and follow-up conversations to discuss what they learned.

A third recommendation is improving sustainability within the host country. This can be initiated by focusing on teaching local people community-oriented health promotion techniques, with less emphasis on administration of long-term medications. Sustainability can be accomplished by staying in touch with key contacts after returning to the United States and by revisiting the host country regularly.

In conclusion, it is reasonable to say that STMMT participants experienced teamwork, a sense of enhanced adaptability, a broadened worldview, increased sense of purpose, and plans to engage in changes to nursing practice at home.

Web Resources

References

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Keywords:

international service learning; Leininger's transcultural nursing theory; nursing; phenomenology; short-term medical missions

InterVarsity Christian Fellowship